Two Tips for Placing Screw-Retained Implant Crowns

August 23, 2021 Kelley Brummett DMD

Most of us are placing implant crowns, using screw retained crowns. If the crown needs to be recovered, or the screw needs to be changed or tightened, the restoration can be removed by accessing the screw through the screw channel.

One of the main advantages of screw-retained crowns is the ease of retrieval. I have discovered two ways to make retrieval easier for myself, which involve the colors of the Teflon tape and composite I use.

  1. Now I have colored Teflon tape on hand, and when I place the screw, I put colored tape on top of the screw instead white tape. If I need to remove the composite, I more readily see my gray or yellow tape than I would white tape.
  2. I also like to use a composite color that is not be an exact match with the implant crown. This way I can easily see the material to be removed to access the screw channel… if I need to remove the crown.

If you plan ahead to have colored Teflon tape on hand, you can do what I do. Teflon tape is available in multiple colors at Home Depot and other hardware stores.

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Kelley Brummett DMD

Dr. Kelley D. Brummett was born and raised in Missouri. She attended the University of Kansas on a full-ride scholarship in springboard diving and received honors for being the Big Eight Diving Champion on the 1 meter springboard in 1988 and in 1992. Dr. Kelley received her BA in communication at the University of Kansas and went on to receive her Bachelor of Science in Nursing. After practicing nursing, Dr Kelley Brummett went on to earn a degree in Dentistry at the Medical College of Georgia. She has continued her education at the Pankey Institute to further her love of learning and her pursuit to provide quality individual care. Dr. Brummett is a Clinical Instructor at Georgia Regents University and is a member of the American Academy of Cosmetic Dentistry. Dr. Brummett and her husband Darin have two children, Sarah and Sam. They have made Newnan their home for the past 9 years. In her free time, she enjoys traveling, reading and playing with her dogs. Dr. Brummett is an active member of the ADA, GDA, AGDA, and an alumni of the Pankey Institute.

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How Long Does a Crown Last?

February 22, 2021 Lee Ann Brady DMD

How long does a dental crown last? The answer is, “It depends.” In this blog, I will review how I manage answering this question for my own peace of mind and to reduce disappointment for my patients.

All of us can think about crowns that are currently in our patients’ mouths that have been in four decades or more…crowns that are doing fine. Sometimes, we look at a bite wing of one of these restored teeth and see space enough “to drive a truck” between the margin and the natural tooth structure. Yet, the crowned tooth is fine with no caries.

We also can think about crowns in our patients’ mouths that needed to be or now need to be replaced within five years or under…perhaps, even within two years. Some of these crowns were carefully and beautifully done.

We have a habit of thinking: The better our skill is, the greater is the longevity of the crown. We need to get away from this generalization because there are numerous factors that impact longevity.

Yes, the dentist’s skill is a factor as are the amount of time and energy we put into making it exquisite, the quality of the laboratory, and the materials. But the other part of the equation is that we put dentistry into the mouths of human beings, and human beings come with risk factors. The most common reason we replace a crown or filling is recurring caries. We see some patients who have new carious lesions every time we see them in the dental chair. They are at high risk. At the other end of the spectrum, we have patients who have not had a carious lesion in multiple decades. The functional risk of the patient is the second primary risk factor. We have patients who can break any type of crown, and we have other patients who have no evidence of functional risk.

What do I say to my patients? I tell them dentistry does not last forever, and there are challenges in predicting the lifespan of their restorations. I do not say, “When your crown fails at some point in the future, it will need dental treatment again.” Instead, I say, “We’re going to treat this tooth with a crown. At some time in the future, it will need treatment again.” Then I say, “The most common reason why a crown needs to be replaced is dental decay around and under the crown, and what we know about you is that you tend to get cavities [or not get cavities]. The second most common reason we replace crowns is that they break. The materials cannot withstand the forces. And what we know about you is that you are tougher on your teeth [or not as tough on your teeth] compared to many other people. “

This type of conversation makes most dentists nervous. They fear the patient will not want to do the crown if the patient knows they will eventually need to retreat the tooth. That has not been my experience. The reality that cars do not run forever does not stop us from buying a new car. The knowledge that your roof will last 10 to 14 years does not stop us from replacing the roof. The reality that the tooth will need retreatment in the future does not stop us from having it treated now.

Setting realistic expectations results in less patient frustration, sadness, and disappointment. It also lessens conflict between the dentist and patients. I want my patients to understand the reality that dentistry does not last forever. It all has a lifespan, just like a car or washing machine. Any tooth we treat will need to be treated again. I also want them to know their risk factors for decay or breakage relative to other patients. Is it high? Is it low? Is it somewhere in between? We can then have a conversation about what they can do and what we can do together to minimize those risk factors.

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Capturing an Exquisite Crown & Bridge Impression

August 28, 2019 Lee Ann Brady DMD

Capturing an exquisite final impression is our goal every time. Getting this result can be one of the most challenging things we do in dentistry. In addition to being masterful in taking an impression and handling the materials, we also must manage the oral environment properly.

Improving the Gingival Tissue Prior to the Impression Appointment

For crown and bridge impressions this process has to begin with optimal tissue management, and tissue management always begins before tooth preparation. Old restorations with poor margins often compromise hygiene with resultant irritated and inflamed gingival tissues. If the tissue is inflamed at the time, we recommend the tooth be crowned, we apply chlorhexidine varnish (Cervitec Plus – Ivoclar Vivadent). When the patient returns for impressions, tissue health is vastly improved.

Managing the Gingival Tissue for Tooth Preparation

Tooth preparation itself can result in difficulty managing the tissue. My preference is always to leave margins supragingival if that is clinically appropriate. My second choice is equigingival, where the margins are right at the crest of the tissue. If the margins are to be placed subgingival, I want to avoid cutting the tissue and then having to manage bleeding. If my initial margin placement is equigingival, I place a primary cord to move the tissue out of the way. This allows me to now drop the margin subgingival with minimal trauma to the tissue.

Retraction of the Gingival Tissue for the Impression

Once tooth preparation is complete, retraction creates a space for the impression material to go past the margin apically so that we can create the proper emergence profile of the restoration. There are many ways to retract prior to an impression. I personally use a second or top cord with a larger diameter than the primary cord I placed to move the tissue for subgingival preparation. If the tissue is bleeding after the placement of the top cord, I place 3M’s “Retraction paste” as a hemostatic agent. This allows for optimal control of bleeding without worry of negatively impacting the set of my impression materials or staining the prep or gingival tissues.

Taking the Final Impression

The final impression is taken with Flexitime impression material (Kulzer). I have my assistant load the tray with heavy body material. I first wet the top cord, so I do not cause bleeding upon removal. The area is now thoroughly dried to allow for proper contact of the impression material to the tooth and tissue surfaces. I inject Flexitime CorrectFlow (Kulzer) and then seat the impression tray. I hold the tray for the full intra-oral set time and do not allow patients to close or bite on the tray, as movement can negatively impact the accuracy of the impression.

Is the impression perfect?

Once removed I inspect the impression using magnification to assess that I have adequate flash beyond the margins of the light body, no pulls, voids, drags or evidence that the impression moved. There is no way to correct an impression for errors. If errors occur, we repeat the process from the beginning to take a new impression.

Check out some of my short videos about impressions on Restorative Nation at https://restorativenation.com/?s=impression.

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About Author

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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